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Current Treatment Options in Patients with Endometrial Cancer

Department of Obstetrics and Gynecology, Medical School, University of Patras, Rion, Greece

*Corresponding Author:

Georgios Androutsopoulos, MD
Lecturer, Department of Obstetrics and Gynecology
Medical School, University of Patras, Rion 26500, Greece
Tel: +306974088092
E-mail: androutsopoulos@upatras.gr

Received date: December 12, 2012; Accepted date: December 12, 2012; Published date: December 14, 2012

Citation: Androutsopoulos G (2012) Current Treatment Options in Patients with Endometrial Cancer. J Community Med Health Educ 2:e113. doi: 10.4172/2161-0711.1000e113

Copyright: © 2012 Androutsopoulos G. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Endometrial cancer (EC) is the most common malignancy of the female genital tract and occurs primarily in postmenopausal women [1]. Overall, about 2% to 3% of women develop EC during their lifetime [1]. The most common symptom present in patients with EC is abnormal uterine bleeding [2].

Based on clinical and pathological features, EC is classified into 2 types [3]. Type I EC, represents the majority of sporadic EC cases (70-80%), is usually well differentiated and endometrioid in histology [3]. Type II EC, represents the minority of sporadic EC cases (10- 20%), is poorly differentiated and usually papillary serous or clear cell in histology [3].

Surgery is the primary treatment for patients with EC [2,4]. Systematic surgical staging for most of them is the baseline therapy and allows clear decision for stage related postoperative adjuvant therapy [5].

In patients with EC, systematic surgical staging includes: total hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy and complete resection of all diseases. Especially in patients with type II EC, systematic surgical staging includes additional omentectomy and biopsy of any suspected lesion [6]. Pelvic washings are no longer part of FIGO surgical staging system for EC, but may be reported separately [7].

Appropriate surgical staging provides prognostic and therapeutic benefits for women with EC [2,5]. It facilitates targeted therapy to maximize survival and to minimize the effects of under treatment (recurrent disease, increased mortality) and potential morbidity associated with overtreatment (radiation injury) [5].

Pelvic and para-aortic lymphadenectomy is essential for surgical staging in patients with EC [4,5]. It has diagnostic and therapeutic value [4,8]. It can be used to deine accurately the extent of disease and determine the prognosis of EC patients [4]. As 15% to 20% of EC patients harbor para-aortic disease alone, the need for complete pelvic and para-aortic lymphadenectomy cannot be ignored [5,9,10]. Undoubtedly, it is the only way to identify stage IIIC patients with EC [7]. Also, it provides a rationale for the need, type and extent of postoperative adjuvant treatment [4,8,11].

Additionally, pelvic and para-aortic lymphadenectomy seems to have a therapeutic effect in women with EC [12-14]. It is associated with improved survival, in patients with type II EC and in patients with advanced stage disease [2,12,13,15,16]. However, it has no effect on survival, in patients with early stage type I EC [2,17,18].

The extension of pelvic and para-aortic lymph node dissection (more than 14 lymph nodes) is an independent risk factor for postoperative complications [17,19,20]. Also in elderly EC patients and in EC patients with relevant co-morbidities (obesity, diabetes, coronary artery disease), morbidity must be carefully weighed against any survival advantage [5,21,22].

It seems that pelvic and para-aortic lymphadenectomy can be safely omitted in patients with early stage well differentiated type I EC [5,7,18,20,23]. However it is obvious that pelvic and para-aortic lymphadenectomy should be performed in patients with advanced stage type I EC, as well as in all patients with type II EC [15,24,25]. Also in any case of doubt, lymphadenectomy should be performed rather than abandoned [24].

Traditionally, systematic surgical staging in EC patients is performed through a laparotomy [26,27]. However in EC patients with early stage disease, it may be performed with minimally invasive techniques (laparoscopy, robotic-assisted surgery) [2,26-29].

Laparoscopic approach in early stage EC offer many advantages especially in overweight and elderly patients [5,26-29]. It is associated with smaller incisions, shorter hospital stay, quicker recovery and lower risk of complications (blood loss, wound infection, herniation and ileus) [5,26-29]. Compared with laparotomy, it is associated with similar overall and disease-free survival [26,27]. However, there are relatively small differences in recurrence rates [26,27].

Minimally invasive surgery is an accepted integral surgical tool in the treatment of early stage EC [27,30]. Beginning with laparoscopy and continuing with robotic-assisted surgery, the surgeon may be able to achieve the goal of a systematic surgical staging, with reduced surgical morbidity [21,26,28,29].

In EC patients at increased risk for recurrence or with advanced stage disease, more aggressive management with postoperative adjuvant radiotherapy and/or chemotherapy is required [24]. Postoperative adjuvant radiotherapy includes external pelvic radiotherapy and/or brachytherapy.

External pelvic radiotherapy in EC patients with early stage disease reduces the risk of local recurrences but has no impact on overall survival [5,31-33]. Also, it is associated with significant morbidity and a reduction in quality of life [31,33]. It is used only in high risk EC patients or at advanced stage disease [34,35].

Vaginal brachytherapy in EC patients with early stage disease also reduces the risk of local recurrences but has no impact on overall survival [33]. However, it is well tolerated and associated with less side effects than external pelvic radiotherapy [33]. It is the adjuvant treatment of choice for high-intermediate risk EC patients [33,34].

Adjuvant chemotherapy is the mainstay of treatment for EC patients with locally advanced or metastatic disease [24,36]. The most active chemotherapeutic agents are: taxanes, anthracyclines and platinum compounds [36,37]. Although they achieve high response rates, they have only modest effect in progression free survival and overall survival [36].

However, the combination of adjuvant chemotherapy and radiotherapy is promising in high risk EC patients and at advanced stage disease [36,38]. It seems that combination is more effective than radiotherapy alone [36].

Molecular targeted therapies have still shown modest effect in unselected EC patients [36]. They usually target the inhibition of EGFR, VEGFR and PI3K/PTEN/Akt/m TOR signals pathways [39]. Perhaps they may be clinically active as adjuvant therapy in welldefined subgroups of type II EC patients with EGFR and ErbB-2 over expression [40].

Conflict of Interest

I declare that I have no conflict of interest.

References

1. Jemal A, Siegel R, Ward E, Murray T, Xu J, et al. (2006)
2. Sorosky JI (2012)
3. Doll A, Abal M, Rigau M, Monge M, Gonzalez M, et al. (2008)
4. Bakkum-Gamez JN, Gonzalez-Bosquet J, Laack NN, Mariani A, Dowdy SC (2008)
5. American College of Obstetricians and Gynecologists (2005)
6. Geisler JP, Geisler HE, Melton ME, Wiemann MC (1999)
7. Pecorelli S (2009)
8. Mariani A, Dowdy SC, Cliby WA, Gostout BS, Jones MB, et al. (2008)
9. Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, et al. (1987)
10. McMeekin DS, Lashbrook D, Gold M, Johnson G, Walker JL, et al. (2001)
11. Mariani A, Dowdy SC, Keeney GL, Long HJ, Lesnick TG, et al. (2004)
12. Cragun JM, Havrilesky LJ, Calingaert B, Synan I, Secord AA, et al. (2005)
13. Kilgore LC, Partridge EE, Alvarez RD, Austin JM, Shingleton HM, et al. (1995)
14. Mariani A, Webb MJ, Galli L, Podratz KC (2000)
15. Lutman CV, Havrilesky LJ, Cragun JM, Secord AA, Calingaert B, et al. (2006)
16. Chan JK, Cheung MK, Huh WK, Osann K, Husain A, et al. (2006)
17. Benedetti Panici P, Basile S, Maneschi F, Alberto Lissoni A, Signorelli M, et al. (2008)
18. Kitchener H, Swart AM, Qian Q, Amos C, Parmar MK, et al. (2009)
19. Franchi M, Ghezzi F, Riva C, Miglierina M, Buttarelli M, et al. (2001)
20. May K, Bryant A, Dickinson HO, Kehoe S, Morrison J (2010)
21. Lachance JA, Darus CJ, Rice LW (2008)
22. Lowery WJ, Gehrig PA, Ko E, Secord AA, Chino J, et al. (2012)
23. Mariani A, Dowdy S, Podratz K (2009)
24. Marnitz S, Köhler C (2012)
25. Nezhat F, Chang L, Solima E (2012)
26. Galaal K, Bryant A, Fisher AD, Al-Khaduri M, Kew F, et al. (2012)
27. Walker JL, Piedmonte MR, Spirtos NM, Eisenkop SM, Schlaerth JB, et al. (2012)
28. Walker JL, Piedmonte MR, Spirtos NM, Eisenkop SM, Schlaerth JB, et al. (2009)
29. Nezhat F (2008)
30. Fleming ND, Ramirez PT (2012)
31. Creutzberg CL, van Putten WL, Koper PC, Lybeert ML, Jobsen JJ, et al. (2000)
32. Keys HM, Roberts JA, Brunetto VL, Zaino RJ, Spirtos NM, et al. (2004)
33. Kong A, Johnson N, Kitchener HC, Lawrie TA (2012)
34. Nout RA, Smit VT, Putter H, Jurgenliemk-Schulz IM, Jobsen JJ, et al. (2010)
35. Chino JP, Jones E, Berchuck A, Secord AA, Havrilesky LJ (2012)
36. Hogberg T (2011)
37. Fleming GF, Brunetto VL, Cella D, Look KY, Reid GC, et al. (2004)
38. Schwandt A, Chen WC, Martra F, Zola P, Debernardo R, et al. (2011)
39. Dedes KJ, Wetterskog D, Ashworth A, Kaye SB, Reis-Filho JS (2011)
40. Konecny GE, Santos L, Winterhoff B, Hatmal M, Keeney GL, et al. (2009)